The Burden of Full and Subsyndromal Posttraumatic Stress Disorder in Police Who Responded to the World Trade Center Disaster

Researchers reveal new findings in the Journal of Psychiatric Research

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Amsterdam, June 5, 2012 – Studies have found that police demonstrated considerable resilience to posttraumatic stress disorder (PTSD) compared to other disaster workers after the September 11, 2001 terrorist attack on the World Trade Center (WTC). This has been attributed to effective screening and extensive training in the police force. New research suggests that, despite this greater resilience to PTSD, 15.4% of police endorse symptoms of subsyndromal PTSD that do not reach the level for a formal diagnosis of PTSD, but which are nonetheless associated with elevated rates of other psychiatric disorders and functional difficulties. The study is published online in advance of publication in the July issue of the Journal of Psychiatric Research.

“The prevalence of full PTSD observed in this study (5.4%) was comparable to previous studies of police responders to the WTC disaster. However, the rate of subsyndromal PTSD was nearly 3 times greater (15.4%), suggesting that one in five police exposed to WTC rescue and recovery work may have clinically significant WTC-related PTSD symptoms,” says lead investigator Robert H. Pietrzak, PhD, MPH, of the National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, and Department of Psychiatry, Yale University School of Medicine. “Further, subsyndromal PTSD, which is not commonly assessed as part of screening efforts, was associated with elevated rates of comorbid psychiatric disorders, functional difficulties, somatic symptoms, and perceived need for mental health care.”

Researchers assessed 8,466 police who worked or volunteered as part of rescue, recovery, restoration, or cleanup in Manhattan south of Canal Street, at the barge-loading piers in Manhattan, or the Staten Island landfill between September 11 and December 31, 2001. Participants completed an initial evaluation as part of the World Trade Center Medical Monitoring and Treatment Program. An interview assessed level of WTC exposure, such as early arrival, being caught in the dust cloud, or exposure to human remains. A range of self-report psychiatric assessments were completed, including measures of depression, panic disorder, and alcohol use; impairment in work, social or family life; and somatic symptoms, such as feeling run down or having headaches. Respondents identified important sources of social support while working at the WTC site, including spouse/partner, supervisor, and co-workers. They also indicated whether they thought they would need any mental health services in the next year. The level of posttraumatic stress was measured using the PTSD Checklist.

WTC-related work exposures that were most strongly associated with full and subsyndromal PTSD were losing someone on 9/11 and knowing someone who was injured in the disaster. A greater number of stressors prior to 9/11 was also associated with both full and subsyndromal PTSD. Union membership and greater family support played a protective role. Depression, panic disorder, alcohol use problems, and somatic symptoms and functional difficulties were highest among police with full PTSD, and occurred in intermediate levels among those with subsyndromal PTSD.

Police with subsyndromal PTSD were nearly five times as likely as controls to report that they might need at least one of the mental health services assessed, such as one-on-one counseling, stress management or psychotropic medication. “This finding underscores the importance of assessing for subsyndromal PTSD in disaster-exposed police responders, as these individuals may be overlooked despite some of these responders having an increased perception of need for mental healthcare,” explains Dr. Pietrzak.

Dr. Pietrzak and colleagues note that subsyndromal PTSD is not a diagnostic classification and may not be routinely identified as part of screenings in police and other disaster response personnel. “Current screening and diagnostic criteria for disaster-related PTSD may be too restrictive in identifying the full complement of police who have clinically significant psychiatric and functional difficulties after responding to a mass disaster. These findings underscore the importance of screening, monitoring, and possibly treating disaster responders with subsyndromal PTSD,” he concludes, adding that additional research is needed to confirm these findings using structured diagnostic interviews, to understand the longitudinal course of subsyndromal PTSD, and to evaluate the generalizability of these results to the broader population of police WTC responders.

Co-authors on this report included Clyde B. Schechter, MD, of the Albert Einstein College of Medicine of Yeshiva University, Evelyn J. Bromet, PhD, and Benjamin Luft, MD, of Stony Brook University, Craig L. Katz, MD, Fatih Ozbay, MD, Vansh Sharma, MD, Michael Crane, MD, Robin Herbert, MD, Stephen Levin, MD, and Philip Landrigan, MD, of the Mount Sinai School of Medicine, Dori B. Reissman, MD, of the National Institute for Occupational Safety and Health, Denise Harrison, MD, of the New York University School of Medicine, Jacqueline M. Moline, MD, of the Hofstra North Shore-Long Island Jewish School of Medicine, Jeanne M. Stellman, PhD, of Columbia University, Iris G. Udasin, MD, of University of Medicine and Dentistry of New Jersey, and Steven M. Southwick, MD, of the National Center for Posttraumatic Stress Disorder and Yale University School of Medicine.

This project was supported by the Centers for Disease Control and Prevention, National Institute of Occupational Safety and Health (contract 200-2002-0038 and Grant 5U1O 0H008232), the American Red Cross Liberty Fund, The September 11th Recovery Program, The Bear Stearns Charitable Foundation, The September 11th Fund, and The Robin Hood Foundation Relief Fund. The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, the U.S. Public Health Service, or the Department of Veterans Affairs National Center for Posttraumatic Stress Disorder.

About the Journal of Psychiatric Research (www.journalofpsychiatricresearch.com)Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research:

Clinical studies of all disciplines relating to psychiatric illness, as well as normal human behavior, including biochemical, physiological, genetic, environmental, social, psychological, and epidemiological factors

The growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology, and computer sciences

Advances in basic and clinical research methodology, including the process of "bench-to-bedside" transfer of new research findings

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